Migration pathways and HIV care Cascade among newly enrolled adult patients in a tertiary clinic in Montréal, Canada.

OBJECTIVES: Migrants are disproportionately affected by HIV and face inequities in accessing care. This study examined the HIV care cascade among newly registered adults at the Chronic Viral Illness Service (CVIS). METHODS: We conducted a retrospective cohort study of adults (≥18 years) living with HIV and newly registered at the CVIS, in Montréal, Canada, between January 1st, 2022, and December 31st, 2024. Sociodemographic, clinical and care cascade data were extracted from electronic records. Multivariable logistic regression models, adjusted for age, gender, region of birth and diagnosis type, examined associations between seven migration status categories and cascade outcomes. RESULTS: Among 695 patients, 664 (95%) were born outside Canada and 528 (76%) were refugees/asylum seekers. Of these, 281/695 (40%) had a new HIV diagnosis. Among newly diagnosed refugees/asylum seekers, median time from diagnosis to linkage to care was 28 days (interquartile range [IQR]: 18-42). Median time from linkage to antiretroviral therapy (ART) prescription ranged from 0 (IQR: 0-0) to 18 (IQR: 9-27) days across groups. At 6 months, 618/695 (89%) were retained in care and 603/618 (98%) were on ART. At 12 months, 530/603 (88%) were in care and 511/530 (96%) were virally suppressed. In exploratory adjusted analyses, Canadian citizens had lower odds of retention (aOR 0.32, 95% CI 0.14-0.75) and viral suppression (aOR 0.33, 95% CI 0.15-0.75) at 12 months. CONCLUSIONS: Among newly diagnosed refugees/asylum seekers, linkage to care delays appear to have increased since pre-pandemic estimates. Meaningful heterogeneity across migration groups highlights the limitations of treating migrants as a homogeneous population in HIV care.